WAIVER FORM
MOUNTANALOGUE.CO.UK
Informed Consent
I understand that use of the Lucia no.03 Hypnagogic Light is at the liability of the user..
It is not to be used by children under the age of 16, pregnant women, sufferers of strobe intolerance due to a psychological condition such as a psychosis, anxiety disorder, sufferers of photosensitive epilepsy or individuals who have medical conditions with tendencies to have epileptic incidents.
I have been made aware that on rare occasions deep trance states can be accompanied by convulsions and/or flashbacks.
Signed:
Print Name:
Email address:
Date:
Informed Consent
I understand that use of the Lucia no.03 Hypnagogic Light is at the liability of the user..
It is not to be used by children under the age of 16, pregnant women, sufferers of strobe intolerance due to a psychological condition such as a psychosis, anxiety disorder, sufferers of photosensitive epilepsy or individuals who have medical conditions with tendencies to have epileptic incidents.
I have been made aware that on rare occasions deep trance states can be accompanied by convulsions and/or flashbacks.
Signed:
Print Name:
Email address:
Date:
